1720065535 NPI number — DR. LAWRENCE T WILLIAMS DO

Table of content: DR. LAWRENCE T WILLIAMS DO (NPI 1720065535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720065535 NPI number — DR. LAWRENCE T WILLIAMS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LAWRENCE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720065535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 242848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36124-2848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-270-9914
Provider Business Mailing Address Fax Number:
334-270-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-263-3344
Provider Business Practice Location Address Fax Number:
334-263-9518
Provider Enumeration Date:
12/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  DO100 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04-00968 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000027084 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".